Persistent post-operative pain procedures

The incidence of persistent post-operative pain varies not only with the operations involved but also with the methodologies utilized to collect and evaluate data. Table 9.1 presents the results of one such epidemiological exploration focusing on the incidence of this condition with selected surgical procedures. 

One of the most significant factors related to the importance of addressing this post-operative condition is the observation that the number of surgical procedures that are at risk has increased markedly over the decade. Subsequently, if we do not address the pathways and treatments of these chronic pains, the prevalence will probably increase. In turn, the physical, social and economic burden will also increase. In one study with post-thoracotomy patients, persistent post-operative pain limited normal daily activities in more than 50% of these patients and sleep disturbances were reported in 25-30% of this population. These disruptions are often driven by inadequate pain control. 

There is a risk of persistent post-operative pain with any surgery and the list is growing. However, some of these operative procedures have received more scrutiny and investigation than others. 

Overall, persistent post-operative pain exists with many operative procedures and the incidence varies, but its impact may be based on the number of these operations performed. It is of particular interest to note that the theoretically less invasive procedures still result in this chronic condition. One would suggest that there is much more for us to learn about this condition and how to standardize evaluations defining cause and effect. In general, however, research methodologies need to improve in order to better understand the operative risks and how to minimize their impact. 

Anesthetic and analgesic use has also been evaluated as a possible contributor to persistent post-operative pain. One study has suggested that properly used r ional anesthetic techniques can reduce the incidence of chronic post-thoracotomy pain. In another study evaluating patients imdergoing thoracotomy procedures, it was shown that nearly 50% of the patients taking opioid analgesics prior to surgery developed... 

Predicting the occurrence of persistent post-operative pain begins with an understanding of the surgical procedure (and specific techniques) described above. 

Probably the most obvious way to reduce the development of persistent post-operative pain is to utilize surgical techniques that avoid damage to major nerves. In inguinal hernia repair, laparoscopic procedures as opposed to open procedures where possible can possibly reduce the risk of nerve injury. In addition, lightweight mesh may reduce the inflammatory response following surgery although, as noted above, some... 

There is little debate that persistent post-operative pain is an important phenomenon for us to consider and better understand. As in many areas of science and medicine, there is much to he learned from identifying those at risk to provide treatment to minimize the personal, healthcare, and psychological burdens. While disagreement exists as to description, quantification, differentiation, and management of these patients, it is this spirit that propels us forward to produce more research in this area from the bench (pathways, genetics) to the bedside (pre- and post-operative and less disruptive surgical procedures). 

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